Lorenz Curves: A New Model for the Distribution of Psychiatric Services

The growth of child and adolescent psychiatric services based on the wraparound philosophy raises new questions for medical directors, investigators, and clinicians interested in improving quality of care and outcomes. Typically, quality improvement studies have focused on standardizing care and decreasing variation while community based services following a wraparound model are by definition individualized. To date, little information on how to evaluate such services in a managed care environment has been available. We present one option for evaluating the distribution of medical services and the extent to which providers individualize services for children with severe emotional disorders. Specifically, we (a) review the philosophy and goals of wraparound services, (b) introduce the Lorenz curve as a tool for determining the degree of inequality in service distribution at a given institution, and (c) present a case study on the use of Lorenz curves by a Medicaid Behavioral Health Organization in profiling behavioral providers.     

Exemplarist Environmental Ethics

This article argues that environmental ethics can deemphasize environmental problem‐solving in preference for a more exemplarist mode. This mode will renarrate what we admire in those we have long admired, in order to make them resonate with contemporary ethical needs. First, I outline a method problem that arose for me in ethnographic fieldwork, a problem that I call, far too reductively, “solution thinking.” Second, I relate that method problem to movements against “quandary ethics” in ethical theory more broadly. Third, I discuss some interpretive work I am engaged in about Henry David Thoreau and how it bears on the methodological issues my fieldwork raised. I argue that some of the most important icons of right relation to environment, especially Francis of Assisi and Thoreau, should be envisioned as far more politically invested than they usually are. They demonstrate to scholars of religious ethics that an exemplarist ethic focused on character need not neglect politics.     

“Yours,Thirsty for Honesty,Ferenczi”: Some Background to Sandor Ferenczi's Pursuit of Mutuality

The American Journal of Psychoanalysis -     

Accuracy in perceptions of interpersonal interactions: effects of dysphoria, friendship, and similarity.

Conflicting views of depressives' interpersonal accuracy were addressed in an investigation of the accuracy of mild depressives (dysphorics) across differing social contexts. Women who were either friends or strangers and who were either similar or dissimilar in level of dysphoria conversed about 3 topics: a neutral topic, their own disclosure of a personal problem, and their partner's disclosure. Dysphorics were not more accurate in general than nondysphorics. After self-disclosure, all women more accurately detected sympathy from a similar stranger. After the partner's disclosure, women also better detected the mood of a similar partner. When interacting with nondysphoric strangers, however, dysphorics underestimated their partner's sympathy toward them. Implications for cognitive and interpersonal theories of depression and for depressives' relationships are discussed.     

Effect of CS-US pairings on shock-elicited aggression as a function of US intensity

In two experiments with paired rats, the effect of superimposing CS-US pairings on a baseline of shock-elicited aggression was studied. Baseline shocks (3.0 mA, 0.125-sec duration) occurred at a rate of 20 shocks per min throughout each session. In Experiment I, each independent group of two pairs of subjects received (in addition to baseline shocks) US shocks of 1.0, 3.0, or 5.0 mA and 5-sec duration, each shock signalled by a 1-min CS. At all three US intensities, aggression increased during the CS. In Experiment II, pairs of subjects received each unconditioned stimulus intensity in a within-subjects design. This procedure revealed a direct relationship between rate of responding and unconditioned shock intensity.     

CS duration,amount, and concentration effects in conditioning taste aversions

The relative contributions of the duration, amount, and concentration of a taste CS were assessed in pairings with an ionizing radiation US in two experiments. Increasing the duration of the CS (0.1% saccharin) up to 9 min yielded increasingly better conditioning over a $\text{1}\text{2}\text{-}\text{hr}$ CS-US delay interval. When the concentration of the sacharin was increased, only a few seconds' exposure to the CS was necessary for near asymptotic conditioning. It was observed that the CS duration effect had not been identified earlier because most investigators utilize 10–20 min CS access periods. The role of CS duration in conditioning over a delay was discussed with reference to the probability of the memory of the CS being present at the time of the pairing with the US event.